Essential Components of a Detailed Blood Workup for Lymphoma

Core Laboratory Tests

The National Comprehensive Cancer Network recommends a comprehensive blood workup for lymphoma, including complete blood count with differential, serum lactate dehydrogenase, hepatitis B testing, and a comprehensive metabolic panel as essential components 1, 2
Complete Blood Count (CBC) with differential and platelets is essential for evaluating potential bone marrow involvement, cytopenias, and abnormal lymphocyte populations, as recommended by the National Comprehensive Cancer Network and Annals of Oncology 1, 3
Serum Lactate Dehydrogenase (LDH) is a critical prognostic marker and component of the International Prognostic Index (IPI) for non-Hodgkin lymphoma, according to the National Comprehensive Cancer Network and Annals of Oncology 1, 3
Comprehensive Metabolic Panel evaluates organ function and potential involvement, as recommended by the National Comprehensive Cancer Network 1, 2
Hepatitis B testing is required before initiating anti-CD20 monoclonal antibody therapy, due to the risk of hepatitis B reactivation, as recommended by the National Comprehensive Cancer Network 1, 2

Hepatitis C testing is particularly important for high-risk patients and those with splenic marginal zone lymphoma, according to the National Comprehensive Cancer Network 1, 2
Coagulation studies, including prothrombin time, partial thromboplastin time, and fibrinogen, assess for disseminated intravascular coagulation, as recommended by Annals of Oncology and Journal of Clinical Oncology 4, 5
Uric acid levels are part of the tumor lysis syndrome panel, especially important before initiating treatment, as recommended by the National Comprehensive Cancer Network and Journal of the National Comprehensive Cancer Network 1, 6

Flow cytometry is essential for determining lymphoma subtype and clonality, according to the National Comprehensive Cancer Network 2, 7
The initial immunophenotyping panel should include pan-B cell markers (CD19, CD20, CD22) and pan-T cell markers (CD3, CD5), as recommended by the National Comprehensive Cancer Network 2, 7

Bone marrow biopsy with or without aspirate is an essential component of staging in most lymphomas, as recommended by the National Comprehensive Cancer Network 1, 2
Bone marrow involvement occurs in 39% of low-grade lymphomas, 36% of intermediate-grade lymphomas, and 18% of high-grade lymphomas, according to the National Comprehensive Cancer Network 1

β2-microglobulin is an important prognostic marker, especially in follicular lymphoma, as recommended by the National Comprehensive Cancer Network and Annals of Oncology 1, 4
Protein electrophoresis is recommended for evaluation of potential paraproteinemia, according to Annals of Oncology 3
Specific genetic/molecular testing is based on suspected lymphoma subtype, as recommended by the National Comprehensive Cancer Network 2, 9

For pediatric patients, additional tests include tumor lysis syndrome panel (LDH, uric acid, potassium, phosphates, calcium), as recommended by the National Comprehensive Cancer Network and Journal of the National Comprehensive Cancer Network 6, 10
For suspected CNS involvement, lumbar puncture with cerebrospinal fluid analysis should be performed, according to the National Comprehensive Cancer Network and Journal of the National Comprehensive Cancer Network 1, 9
For patients receiving anthracycline-based regimens, cardiac function evaluation with MUGA scan or echocardiogram is recommended, as recommended by the National Comprehensive Cancer Network 1, 2